[CUPE healthcare list] McGill medical professor recommends public solutions for waitlists

["Irene Jansen" <ijansen@cupe.ca>]

Blaming the heroic; Judging hospitals by the length of their waiting lines is unfair to the most overloaded institutions and health workers.
The Gazette (Montreal) 
Wed 11 Apr 2007 
Page: A25 
Section: Editorial / Op-ed 
Byline: MAURICE MCGREGOR 
Source: Freelance 


When something goes wrong with an important service like health care we have to figure out what caused the problem and how to fix it. But it's also important not to blame the innocent. 

The April 1 edition of the magazine Actualite recently reported on the "health" of Quebec's hospitals, basing their evaluations on the time patients have to wait for different procedures. This could help patients choose the institutions in which waiting times are shortest, but it is a disservice to those hospitals and health workers in the most overloaded parts of the health-care system. 

Hospitals develop long waiting times either because they are slow and incompetent, or because they function well but receive more patients than they can manage. 

Without citing a shred of evidence, Actualite simply assumes the blame for excessive wait times lies with the hospitals. It based this extraordinary conclusion on the fact it found wait-time differences among hospitals. 

Do the magazine's journalists imagine the patient load is neatly divided in proportion to each hospital's capacity? According to this logic, if a gasoline crisis were to cause lineups at gas stations, we should blame those with the longest lines of waiting cars for incompetently imposing unacceptable suffering on their customers. 

In broad outline, the real reasons for hospital waits are not difficult to understand. Consider three points: 

There's a major shortage of health-care professionals in Quebec. This is not disputed by anyone. Beds without nurses are useless, so the shortage of nurses becomes a shortage of beds. And because there is a shortage of technicians, equipment such as MRI and CT machines is not maximally used. 

In general, across the Western world there is a fair correlation between the number of physicians and hospital beds per population and the length of waiting times. In both these categories Canada, and Quebec in particular, stand close to the bottom of the list of Western countries. 

To cope with fluctuations in demand, hospitals should not on average work above 85 per cent of capacity. However, our larger big-city hospitals work at around 100 per cent of capacity, so every time the demand surges a little, emergency departments overflow. 

Planned elective surgery gets postponed when demand exceeds capacity. The acutely ill patients who flood in through the emergency departments must always have priority for bed space and operating rooms. So each time demand exceeds supply, the lists of patients with non-acute problems such as hip and knee replacement grow longer. 

Of course there will always be some variation in the effectiveness with which different hospitals cope with overload. But to blame the most overloaded institutions and health workers, who are mostly working heroically and effectively, is an insult to those who most deserve our thanks. 

Have these "experts" forgotten that in the past decade we closed seven hospitals in Montreal, and reduced the bed capacity in all the others,because of funding cuts? Have they forgotten that in the same period we gave generous handouts to encourage our doctors to retire early? 

Actualite's journalists also "discovered" almost all hospitals with long waits are in big cities, and those with the shortest waits are in rural areas. Are they unaware it has long been government policy to direct physicians from the cities to more distant areas? 

Are they not aware big-city hospitals are not allowed to recruit additional specialists to respond to increased demand? So no one should be surprised that the longest lineups are to be found in Montreal and Quebec City. 

So what should be done? The long-term solution is to increase manpower training. This is already in place, but will take time to bring relief. 

What can be done now? We could immediately raise the cap on the number of physicians allowed to work in city hospitals, and remove the cap completely for physicians who are recruited outside Quebec. 

We could immediately suspend the regulation that compels young doctors who come to Quebec for postgraduate training to leave when they are trained. And we could immediately lower the burdensome requirements for registration of foreign doctors, particularly those who come from countries with medical training equivalent to our own. 

As for nurses and essential technologists, we could give the university hospitals financial encouragement to start recruiting outside the province, both for themselves and for their partners, and we could suspend language testing for a period of six months, and make sure when it resumes the level of testing is appropriate for the objective (to communicate with patients). Potential recruits who might well want to learn French cannot afford to risk losing their jobs if they fail. So they go elsewhere, where pay is often better anyway. 

What should we not do? 

We should not, at least until health manpower numbers have been restored, "cure" overcrowding of the public system by allowing private, for-profit health-care services to develop at the expense of our limited health manpower pool. 

While this would allow the wealthy to avoid waiting it would be the last straw for our otherwise excellent public system. 

Maurice McGregor is professor emeritus of medicine at McGill University. 

Illustration:
* Photo: PETER MARTIN, THE GAZETTE / Waiting-room lineups are no test of a hospital's competence or effectiveness.


Edition: Final 
Length: 848 words